=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659701514
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSANNE HOBEN MA, LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2013
-----------------------------------------------------
Last Update Date | 10/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1508 W MAIN ST
-----------------------------------------------------
City | ROBINSON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62454-3819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-678-9180
-----------------------------------------------------
Fax | 224-678-9369
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16453 N 1150TH ST STE 102
-----------------------------------------------------
City | HUTSONVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62433-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-545-7378
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 180.012219
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------